Abstract B006: Reduced survival outcomes in lower income quintile groups for women with breast cancer treated with chemotherapy in Ontario, Canada
Notice bibliographique
Résumé
Abstract Background: Despite the comparably comprehensive healthcare system in Canada, health inequities are widespread, and this holds true for breast cancer patients in Ontario. It is thus essential to learn if socio-demographic disparities continue after diagnosis of breast cancer, and if these contribute to higher mortality rates in the lower income quintile groups. Methods: We conducted a real-word population-based study using a provincial health administrative dataset from Ontario, Canada. We included patients diagnosed with HER2-negative breast cancer, treated with surgery and adjuvant chemotherapy, between 2009 to 2017. We used log-rank test and Kaplan Meier curves to compare overall survival (OS) between breast cancer populations among income quintile groups, and Cox regression to evaluate risk factors, using hazard ratio (HR) and 95% confidence intervals (CI). Results: We analysed 10,634 women diagnosed with stage I-III breast cancer. At diagnosis, in the Q1 group, there were 248 (15.8%) women with stage I, 997 (63.7%) with stage II, and 320 (20.45%) with stage III. In the Q5 group, there were 568 (22.15%), with stage I, 1,532 (59.75%) with stage II and 464 (18%) with stage III. Comparison between those in the lowest versus highest income quintile groups, and lymph node (LN) status at diagnosis, showed that in Q1, 534 (34%) women had LN 0 and 897 (57.3%) had LN+. In Q5, there were 954 (37.2%) women with LN 0 and 1,379 (53.8%) with LN+. Similarly, comparing tumor size (TS) at diagnosis, we found that in Q1, there were 463 (32.2%) women with TS≤ 2 cm and 974 (67.8%) with TS > 2 cm. In Q5, 915 (39%) women had TS≤ 2 cm and 1,426 (61%) had TS > 2 cm. In the Q1 group, there were 325 (20.7%) patients who received non- anthracycline and 1,240 (79.3%) treated with anthracycline-taxane chemotherapy. In Q5, there were 673 (26.2%) women treated with non-anthracycline and 1,891 (73.8%) who received anthracycline-taxane chemotherapy. The OS analysis based on the household income group compared to Q5 showed a substantial difference in the Q1 (HR 1.52, 1.2–1.9, p = 0.0002) and Q2 (HR 1.34, 1.1–1.7, p = 0.006) groups. In Cox regression models, Q5 group and endocrine receptor (ER) positive were significantly associated with reduced mortality risk. There was a significant correlation between increased risk of death and the following: receipt of non- anthracycline chemotherapy, TS > 2 cm, LN+ and grade 3 histology. Conclusion: Our study found an uneven distribution of breast cancer patients between the lowest and highest income quintile groups. Women with HER2-negative breast cancer who were part of the lower income quintile groups, thereby likely with a socioeconomic disadvantage, had the lowest OS. At diagnosis, these women were more likely to have more advanced breast cancer staging, including larger tumors, LN+, and receive anthracycline-based chemotherapy as compared to those with higher household income. Further research is warranted to identify the key social determinants that are systematically associated with disparities in equitable access to care. Citation Format: Danilo Giffoni M. M. Mata, Rossanna C. Pezo, Kelvin K.W. Chan, Ines Menjak, Andrea Eisen, Maureen Trudeau. Reduced survival outcomes in lower income quintile groups for women with breast cancer treated with chemotherapy in Ontario, Canada [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B006.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».